Frontline staff at the Welsh Ambulance Service “lost” nearly 80,000 hours last year waiting to transfer patients into hospitals, figures have revealed.

According to the trust’s Ambulance Quality Indicators (AQI), which look at all aspects of their performance and clinical care, handover delays totalled hours 76,691 in 2017 – the equivalent of 3,195 days or eight-and-a-half years.

That was a significant rise on 2016 when handover delays totalled 59,694 hours.

According to NHS Wales guidance, patients should be transferred from an ambulance to a hospital within 15 minutes, with any time over that being classed as a delay.

But only around half of patients were able to be transferred within that timeframe last year.

Outside the University Hospital of Wales' accident and emergency department. Picture by Richard Williams

Scores of ambulances queuing outside emergency departments has become an all-too familiar sight across Wales due to a high influx of patients coming through their doors.

A lack of hospital beds, higher volumes of elderly patients with chronic conditions and delays in setting up social care packages have all been blamed for creating a backlog outside A&E.

Handover Delays for 2017

January to March - 16,606

April to June - 10,658.6

July to September - 10,319

October to December 2017 - 19,554

Darron Dupre, Unison organiser, said ambulance staff on the frontline were being “failed by the system” and were growing increasingly frustrated.

“Every lost hour sat outside an emergency department is felt with a profound sense of frustration by emergency medical teams all across Wales,” he said.

“Indeed it has now become almost a norm that some crews will spend more time stuck in limbo outside of hospitals than actually on the roads saving lives.

“It cannot be right that every month we have a now customary debate on how hard everyone is working and that everyone is ‘committed’ to a more joined-up system. This needs to be translated from hopeful press releases into real, sustainable action."

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He added: “While I have not met one paramedic who says that caring for a patient in their ambulance outside an emergency department is ‘wasted’ time, they do call it ‘lost’ time.

“Lost time in not being able to get to other patients in as timely fashion as they would want for their own families. Lost time because they are being failed by the very system that should be there to underpin their world-class skills and the most life-threatened patients who depend upon them.”

According to the AQI figures, 209,552 patients who called 999 were taken to a hospital or other healthcare destination in 2017.

Welsh Ambulance Service staff experienced the most handover delays in the last quarter of 2017 (October to December) when 19,554 hours were “lost”.

Health boards across Wales say they are doing everything they can to get patients into their hospitals as quickly as possible.

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Betsi Cadwaladr Health Board’s director of secondary care, Nigel Lee, said: “We have made a number of changes to support staff at our hospitals to provide the best care possible and reduce handover times.

“This includes new pathways for patients who have fallen, have breathing difficulties and mental health concerns, which now bypass our emergency departments.

“We have also expanded the community response across north Wales, including additional district nursing working alongside the out of hours services, and direct support to care homes.

“Our staff are working extremely hard to ensure patients receive the best quality of care possible, and we always clinically prioritise the patients with the most immediate need at our emergency departments; we continue to urge the public to choose the most appropriate care such as our urgent care centres (minor injuries units) or advice from a pharmacist for minor ailments.”

He said: “They’re frustrating for our ambulance crews whose time could be spent helping other patients in the community and they’re frustrating for our hospital colleagues who are working flat out to speed up the flow of patients through the emergency department.

“The biggest challenge is that when ambulances are delayed at hospitals, we are unable to respond to other incidents which can mean that 999 callers wait longer for help.

“We’re working collaboratively with our health board colleagues to reduce the number of patients we convey to hospital; currently we only convey around 60% of 999 calls that we receive.

“We’re deploying falls teams to keep uninjured patients at home, and are preventing around 2,000 ambulance dispatches a month by helping patients over the telephone.

“We have positioned nurses and paramedics in police control rooms to coordinate our activity, and we have referral pathways to other NHS services for patients with less serious conditions.

“This month we have also appointed Hospital Ambulance Liaison Officers who work with our crews and hospital staff in order to reduce the time an ambulance spends at the emergency department.

“The public can help us by using our service wisely – last weekend we attended 64 incidents where there was no patient on scene when we arrived.

“We attended 124 calls where the ambulance crew referred the patent back to their GP, and we treated 474 patients at scene with no onward referral required.

“If you’re not sure which service you require, please call NHS Direct Wales on 0845 46 47 (or 111 if you live in Swansea, Neath Port Talbot, Bridgend or Carmarthenshire) for an immediate source of advice.

“There are more than a dozen symptom checkers at www.nhsdirect.wales.nhs.uk which can help you to choose the right treatment, and local pharmacies are also a great source of advice and low cost over-the-counter remedies for many common ailments and symptoms.”

ABMU Health Board describes how it deals with its handovers

"On arrival at the emergency department (ED) all patients are assessed and priority is given to those in a critical or life-threatening condition.

"Regrettably, there are instances when it is sometimes necessary for some patients, usually less serious cases brought by ambulance, to return to an ambulance with paramedics following their assessment.

"This is because of the increasing number and complexity of patients needing our services which can cause some congestion within the ED.

"This is far from ideal, and we apologise to patients who have had this experience.

"However, our top priority is patient safety and in these circumstances this is the safest option.

"During this time patients continue to be seen by medical staff, investigations carried out and treatment given.

"As soon as space becomes available in the department patients are transferred to continue their care.

"Should an ambulance crew receive a top-priority 999 call while waiting outside, the patient is immediately admitted as an extra releasing the crew and ambulance.

"Also, at Morriston Hospital, to help release ambulances we open alternative space where patients from up to three ambulances can wait safely with one ambulance crew releasing the other two crews.

(Image: Peter Bolter)

"At the Princess of Wales Hospital, in Bridgend, we are about to trial a new fast track referral system for patients whose GPs feel they need to see a specialist urgently.

"Currently, GPs give patients a letter to take directly to the hospital where they wait in the ED to be seen by the relevant consultant or surgeon.

"The new system will mean the GP can phone the consultant or surgeon directly to discuss the patient’s case.

"The consultant or surgeon will then advise if the patient needs to attend the hospital and when.

If the patient does need to attend, instead of waiting in the ED they will go directly to an alternative area more suitable for their needs, bypassing the ED.

"It is hoped this will not only reduce waiting times for patients but also make more space available in the ED for ED patients.

"The issue of ambulance delays is not specifically about emergency departments but often due to a lack of patient flow through the health and social care system.

"This can be caused by a higher number than usual of seriously ill patients coming into hospital who stay with us for longer as they need more time to recover, or by delays in discharging patients who no longer need hospital care.

"Good patient flow is very important, because if patients are in beds when they don’t need to be, it often leads to delays in others being admitted.

"Patient flow is NHS-speak for someone’s journey through a hospital, from being admitted to going home, with all the consultations, tests and treatments in between.

"Slow patient flow is a main reason why ambulances sometimes end up queuing outside emergency departments, as patients wait to be admitted.

"Delayed discharge of patients is just one issue which can slow patient flow. Just as important is avoiding patients being admitted if they don’t need to.

"We are doing all we can to reduce delays and see more patients including working closely with colleagues in the ambulance service and other partner organisations, temporarily opening extra beds and ensuring all available clinicians and nurses are seeing patients.

"In addition, we have a number of schemes to ensure patients who no longer require medical treatment in hospital return home or to another safe place on time.

"This is better for patients and helps free up beds for other patients who are very ill and urgently need the bed."